MALAWI COLLEGE OF HEALTH SCIENCES PRESENETATION (1).pptx

College of health science Malawi

1. BIRTH AND DEATH REGISTRATION SYSTEMS IN MALAWI 05/02/2024

2. PRESENTATION OUTLINE Overview of NRB National Registration & Identification System Civil Registration System and Vital Statistic D eath Registration Birth Registration Roles of Registration Functionaries

3. OVERVIEW OF NRB

4. NATIONAL REGISTRATION BUREAU Established in 2003 Derives authority from the N ational Registration Act 2010 Under Ministry of Homeland Security Mandate T o manage and maintain the National Registration and Identification System (NRIS)

5. National Registration and Identification System NRIS has two components: 1. Identification System National Identity Cards 2. Civil Registration and Vital Statistics System Birth registration Death registration Marriage Registration

6. NRIS Objectives To improve internal security by facilitating positive identification of Malawians, Residents and Non-Residents; To improve voters’ registration and identification process in Presidential, Parliamentary and Local Government Elections;

7. NRIS Objectives To facilitate continuous capture of demographic data through compulsory birth and death registration; To improve socio-economic planning by providing up-to-date population information from the “Population Register”.

8. Civil Registration and Vital Statistics System

9. Civil Registration System A system government uses to record vital events as required by laws or regulations of the country There are 10 vital events: Birth, Death, Fetal Death, Marriages, Divorce, Annulment of Marriages, Judicial Separation of Marriages, Adoptions, Legitimation, Recognition Of these Birth and Death are the most important

10. 10 10 Vital Events Top Priority Live birth Death Priority Fetal death Marriage Divorce Lower Priority Annulment of marriage - Invalidation or voiding of a legal marriage … conferring on the parties the status of never having been married to each other Judicial separation of marriage - The disunion of married persons, without there being conferred on the parties the right to remarriage Adoption Legitimation - The formal vesting of a person with the same status and rights of a person born in wedlock, Recognition - The legal acknowledgment, either voluntary or compulsory, of the paternity of a child born out of wedlock.

11. Civil Registration System…… The purpose of CRS is to establish the legal documents required by law (NR Act) It also includes provision of legal identity through birth registration Civil Registration need to be Compulsory, Permanent, Continuous and Universal and must be recorded in REAL TIME

12. Progress made in Civil Registration System : Progress on birth and death registration: Commenced on 1 st August, 2015; Compulsory birth registration in all Health Facilities of 28 districts Introduced community births and death registration in 18 districts Compulsory Death registration introduced in all health facilities in 17 districts and in high volume facilities in 11 districts

13. DATA BASE FOR < 16 YEARS BIRTH CERTIFICATES DATA BASE FOR ≥ 16 YEARS ID CARDS DEATHS FOR ALL AGES POPULATION REGISTER OF ALL PERSONS POPULATION REGISTER –DATABASE STRUCTURE FEEDER CHANNEL FOR IDs

14. DEATH REGISTRATION

15. The National Registration Act provides for Compulsory registration of all death in the country The Act also mandates the District Registrar who is the DC to keep a register of all death in the district The Act also mandates the village heads to register vital events occurring in their villages as Local Registrars. The Director of NRB is mandated to keep a National Register of all deaths occurring in the country The Act and regulations mandates qualified clinicians to certify deaths and ascertain cause of death to all deaths occurring in health facilities

16. Death Registration vs Medical Certification of Death and Cause of Death Death Registration is the registration of the occurrence of death and the demographic data of the deceased. It leads to the issuance of the Death Certificate Medical Certification of death and Cause of death ensures that the cause of each death is ascertained, and mortality data is collected. This is done by qualified Clinicians only Death can be registered without cause of death

17. Benefits of Death Registration and Medical Certification of Death

18. Benefits……… Legal and Permanent RECORD OF FACT of death Death Certificates enables spouses, children and relatives of the deceased person to claim inheritance such as: Land rights, Pensions Insurance benefits, Survivor and spousal benefits, Any legal cases requiring proof of death like right to remarry, claim citizenship, distribution of deceased estate etc

19. Benefits…… Ensures that state entities and businesses that are responsible for disbursement of pensions and other benefits to know quickly when a person has died and to halt certain payments and ensure the transfer of other benefits to the surviving family It provides information to National Electoral bodies to update voter rolls Enables surviving family members to trace their ancestry and family relations over generations long after death of an individual

20. Benefits…….. Medical Certification of death and assignment of cause of death provides MORTALITY DATA which includes rates and trends Helps in etiology and epidemiology ie Helps a country to know who is dying, where, at what age, why, what race Helps know main cause of diseases and plan interventions

21. Benefits…….. Helps study chronic diseases patterns Helps in infant and maternal mortality studies Helps in the study of specific diseases Infectious disease monitoring

22. Benefits…… Generate population estimates and growth projections, Informs research priorities, policy development, planning and resource allocation, and financing, Helps to monitor and evaluating health programs, policies, and new diagnostic and therapeutic techniques, Provides a basis for comparison against global health targets and regional trends,

23. Benefits……. Allows monitoring of progress towards national and international commitments, such as the Sustainable Development Goals (SDGs), Provides closure and peace of mind for bereaved families, Supplementing National ID efforts – creating a dynamic database.

24. Monitoring of SDGs

25. Death Registration Process Death Health Facilities Other than Health Facility Health Facilities with eDRS Health Facilities without eDRS Other places In community Medical Certification of Causes of Death ( MCCoD ) Verbal Autopsy

26. Important Forms in Death Registration Health Facility Death Report Form, NR 10 Community Death Report Form, NR10C Notification/Acknowledgement Slip Village Death Register Burial Report Death Certificate

27. Death in Health Facilities For every death in a health facility, the NR10 must be filled Relatives, nurses and any other person available must fill section 1 and 3 Section 2 can only be filled by a trained clinician Section 2 can be filled later while sections 1 and 3must be filled immediately A dead body can not be taken away from the ward before it is registered, and section 3 issued The mortuary attendants will only receive a dead body after the production of the Acknowledgement Slip

28. THE CENTRAL CODING UNIT A unit established by NRB and Ministry of Health at KCH All section 2s are sent to the CCU for coding The DRO must sent all section 2s to this unit monthly The DEN must be entered on all forms before being sent to the unit Coding involved transforming information on the death report into alpha-numeric codes using the the International Classification of Diseases (ICD) There are specially trained coders Causes of death or Mortality data is generated at the coding unit

29. Name Proportion Unspecified Malaria 10.35 Pneumonia, Unspecified 4.90 Ill-defined and unknown cause of mortality 4.30 Essential (Primary) Hypertension 3.90 Anaemia, Unspecified 2.97 Sepsis, unspecified 2.69 Gastroenteritis and colitis of unspecified origin 2.17 Unspecified human immunodeficiency virus [HIV] disease 2.02 Person Injured in Unspecified Motor vehicle Accident, traffic 1.76 Meningitis, Unspecified 1.57

30. Death in the Communities Mandatory community death registration currently taking place in 18 districts. The form NR10C is used It has no Section 2 All village heads will have the form VH to issue the form to the bereaved family and assist in filling the form VH will also issue the burial report Burial will only take place after the burial report is issued All filled forms will be sent to the DRO for data entry through the TA

31. SPECIAL CASES Unnatural deaths Unnatural death is defined as a death caused by external cause like injury or poisoning which includes death due to intentional injury, such as homicide or suicide, and death caused by unintentional injury in an accidental manner. In almost all cases post-mortem is under taken at request of the police department. For registration purposes, the informant will attach the copy of police report to NR10 form. Section-2 of NR10 form will be completed by the physician conducting the post-mortem. The death will be registered in the health facility with place of death as the case may be.

32. Special cases…. Dead on Arrival (DOA) DoA is defined as a patient who was found to be already clinically dead upon the arrival of professional medical assistance. Relatives brought the body to the hospital for confirmation of death. Informant will fill the NR10 form at the hospital and attending physician/ clinical officer will complete Section-2 of NR10 after interviewing the person who was present at time of death. The death will be registered in the health facility with place of death as the case may be.

33. Missing persons Notification of a missing person is made by next kin with the police department. The courts declare the missing person dead, generally 7 years after report for the missing person is filed with the police. Registration of these presumed dead cases shall be undertaken only on production of court orders which will be attached to the NR10. The next kin of the missing person will act as informant and submit the application to the DRO where the missing person belonged. These cases will be treated as normal registration and place of death will be the place where the person has gone missing.

34. Death Abroad Death abroad is defined as death of a Malawian citizen occurring outside the boarders of Malawi. As per UN Principles and Recommendations, such deaths are to be registered at the place of death and that country should issue death certificate or other similar documents. As per the NR Act, an official of the Malawi embassy in that country will act as a registrar to perform registration functions. In the absence of the above mechanism, the DROs are receiving requests for issue of certificates of deaths that have occurred abroad along with certified copies of the relevant documents by the Oath Commissioner of that country. Place of death will be indicated accordingly under ‘’Others’’.

35. Use of Burial Report Ensure that all deaths are registered The Burial Report and Acknowledgement Slip (Section 3 of NR 10 Form) will be presented to the DRO for collection of Death Certificate Provide data on number of burials undertaken within a territory Help identify unknown death burials Helps when there is need to exhume a body

36. THE ROLE OF THE POLICE THE police has an important role in registering all deaths which are presumed to be unnatural or sudden and unclaimed bodies. In almost all cases post-mortem is undertaken at request of the police department: Provide a copy of Police report to informant for attachment to NR10 Act as informant to register the unclaimed bodies. Collect burial reports in case of the unclaimed bodies

37. Verbal Autopsy Verbal Autopsy is a system of ascertaining probable cause of death for deaths occurring in communities Health information and a description of events prior to death are acquired from conversations or interviews with a person or persons familiar with the deceased and analyzed by health professionals or computer algorithms to assign likely cause(s) of death It is a method of gathering information about symptoms and circumstances for a deceased individual to determine their  cause of death It comprises a set of question that are administered to the caregiver prior to death. This is a WHO VA Standard tool. It is being Piloted in Mchinji and Blantyre and over 1000 Vas have been conducted Currently a first VA report is being written and will be used to scale to other districts

38. FORM NR 13 LOGO OF REPUBLIC OF MALAWI LINE BAR CODE REPUBLIC OF MALAWI NATIONAL REGISTRATION ACT, 2010 CERTIFICATE OF DEATH (Regulation 39) 1. Death Entry Number LL /0000023/2015 2. Registration Number 0000 2 0623 3. Name of Deceased Tom Banda 4. Date of Birth 29 th March, 1963 5. Sex Male 6. Date of Death 21 th September, 2015 7 . Place of Death K C Hospital, Lilongwe 8 . Name of Mother Patricia Banda 9. Name of Father Gift Banda 10.Date of Registration 24 th September, 2015 I hereby certify the above to be a true and correct extract from the Death Register kept at NRB. Dated this 29 th day of September, 2015 Emboss seal Signature of designated person of NRB

39. BIRTH REGISTRATION

40. Birth Registration

41. Importance of Birth Registration Provides accurate data to other government agencies for administration and planning purposes. Serves as a prerequisite to the realization of human rights integral to a child’s development and well being A crucial first step towards building a protective environment against abuse, exploitation, violence and statelessness

42. BENEFITS OF BIRTH REGISTRATION Provide legal proof of the occurrence of the event. Vital for infant health service planning, reproductive health planning, and immunisations programs.

43. Benefits of Birth Registration…. The Birth Certificate: Access to quality social services i.e. health and education Access to inheritance of property Reduction of child trafficking and child abuse Eradication of child labor Acquire citizenship/nationality Right to benefit from social security (social cash transfer scheme)

44. Special Cases Adoptions These are registered after an adoption order has been issued by the court A child can be already registered of not If already, the details of the child are amended in the system adding details of the adopted child The name can change according to the court order Details of the biological parents are maintained in the system If not registered, 2 forms are filled; for the biological parents and the adopting parents Abandoned Child If a child is abandoned at a health facility or brought to hospital Case is reported to social welfare and police Social welfare is responsible for registration and gives name to the child Health facility will determine date of birth Social welfare will be the informant

45. Special Cases Orphans A child deprived off one or both parents through death If one parent is available, they can register F both are dead, guardian or administrator of home must register Social welfare will sign the verification part and provide letter of support.approval Some fields in the system will be relaxed Birth Abroad These are births by Malawians residing outside the country As per UN Recommendations, such births are registered at the place of births and certificates are issued by that country These births are also registered in Malawi for record purposes without necessarily issuing the certificate

46. MASS REGISTRATION OF CHILDREN UNDER 16 There are about 8 million of children under the age of 16 who are not registered, there existence is not documented These can easily be declared stateless according to international standards and practice They are vulnerable to abuse and trafficking Government plans to conduct a mass registration of these children so that they get birth certificates A pilot was implemented in Mwanza, Karonga, Lilongwe Rural East and Karonga Currently they can be registered at DRO at any time

47. BIRTH REGISTRATION PROCESS Birth Health Facilities Other than Health Facility Health Facilities with eBRS Health Facilities without eBRS Other places In community

48. HOW TO REGISTER

49. Discuss WHAT ARE THE ROLES OF THE HEALTH FACILITIES?

50. ROLES OF NRB District Registration Office DR to scrutinize the NR8 Form Enter the data for manual & Home births Software checks for duplicate Software to generate unique BEN (District database) Send the data to NRB for further processing NRB HEADQUARTERS NRB checks the completeness of data (Auto) De-duplication of record (Auto) Software to generate the unique Registration Number BRN(central database-Auto) Software assign 8-digit alpha-numeric national ID number (Auto) Print the BC on special security paper using decentralized facility at all DROs BC can be collected by the informant at health facility , VH or DRO

51. The NSO

52. Thank you